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Vascular > WavelinQ > Flashcards

WavelinQ Flashcards

1
Q

How long should vascular access be placed before you start dialysis?

A

weeks or months

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2
Q

The three basic kinds of vascular access for hemodialysis are

A
  • arteriovenous (AV) fistula
  • arteriovenous (AV) graft
  • venous catheter
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3
Q

Connecting the artery to the vein causes

A

more blood flow to the vein

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4
Q

One important step before starting regular hemodialysis sessions is

A

preparing the vascular access

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5
Q

vascular access

A

which is the site on your body where blood is removed and returned during dialysis.

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6
Q

requires advance planning because a fistula takes a while after surgery to develop—usually from two to six months

A

Arteriovenous or AV Fistula

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7
Q

A surgeon creates an AV fistula by

A

connecting an artery directly to a vein, usually in the wrist or forearm

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8
Q

This method is best suited for the person who chooses to self-cannulate (inserting your own needles)

A

Buttonhole Technique

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9
Q

The most common problem with the AV fistula is a condition known as

A

stenosis

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10
Q

When the needles are inserted into your vascular access for hemodialysis

A

cannulation

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11
Q

The WavelinQ™ EndoAVF System is indicated for the creation of an

A

arteriovenous fistula (AVF)

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12
Q

Why Endo AVF?

A
  • Avoids surgical scarring and minimizes arm disfigurement associated with open surgery
  • Additional anatomical AV fistula locations
  • Multiple venous procedural approaches1
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13
Q

Initial screening questions for EndoAVF:

A
  • Is this patient a healthy patient?
  • Is this patient not a canidate for a more distal AVF?
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14
Q

Who is a canidate for EndoAVF?

A

surgical AVF candidates with proximal forearm perforator
- good inflow & outflow in screening
- vessels that can accommodate device & presence of perforator

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15
Q

In patient selection, the venous outflow must have the cephalic or basilic vein measure at least ___ in diameter

A

2.5 mm

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16
Q

In patient selection, the venous access options must have the ulnar or radial vein measure at least ___ window at the wrist

A

3 inch

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17
Q

In patient selection, the creation site must have:

A

proximal forearm ulnar and radial vessels

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18
Q

(T or F) only the bracial artery should be used for arterial access

A

True

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19
Q

access venous outflow: the direction of the probe when visualizing the perforator in long access can help identify _____ ______.

A

flow domiance

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20
Q

The device cannot create the EndoAVF through:

A

calcified vessels

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21
Q

In order to complete the screening the patient must have at least 1 radial artery and 1 radial vein greater than or equal to ____ in diameter.

A

2 mm

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22
Q

before the case you should scan the arm from the ____ point to the ____ point to note any anatomy challanges.

A
  • access
    -creation
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23
Q

patient requirements for EndoAVF:

A
  • usuable cephalic or basilic vein for fistula outflow
  • has patient perforator
  • ulnar or radial artery and ulnar or radial vein greater than or equal to 2 mm in diameter
  • bracial artery greater than or equal to 2 mm in diameter
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24
Q

the most important aspect of wavelinQ is:

A

patient selection

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25
Q

___% of fistulas fail to mature

A

36

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26
Q

creation/maintenance for WavelinQ:

A

2-3 procedures per year

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27
Q

3 parts of WavelinQ:

A
  1. selection/case planning
  2. creation/maintenance
  3. cannulation
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28
Q

for procedural ease, you want to:

A
  • antegrade over retrograde
  • use the largest vein at the access site
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29
Q

parallel procedure approach

A

access from upper arm

30
Q

anti-parallel procedure approach

A

access fro wrist or upper arm

31
Q

brachial vein access benefits

A
  • larger vein to access
  • arterial guidewire provides guide to venous wire
  • can coil through existing venous sheath post-creation without crossing creation site
32
Q

brachial vein access challenges

A
  • wiring retrograde against valves
  • accessing a deep vein
  • avoiding the median nerve
33
Q

ulnar vein access benefits

A
  • accessing a superficial vein
  • wiring with the valves
  • straighter approach to endoAVF creation site
  • good venography capabilities
34
Q

ulnar vein challenges

A
  • accessing a typically smal vein
  • accessing from two different anatomical locations and directions
  • coiling post creation
  • navigating vessel anomalies due to past trauma
35
Q

superficial vein access benefits

A
  • working from similar access location as the arterial access
  • accessing a large superficial vein
36
Q

superficial vein access challanges

A
  • wiring a retrograde against valves
  • selecting the target vein at the base of the perforator
  • coapting the device at the target lesion site
  • coiling post creation
37
Q

you want to reserve the future ____ _____ ____ for last resort

A

HD cannulation site

38
Q

ulnar creation:

A
  • usually larger
  • our data supports it
  • creation common ulnar under tuberosity
39
Q

distal access advantages:

A
  • valves
    -perforator confirmation
  • hemostasis
40
Q

distal access disadvantages:

A
  • arterial injection
  • marrying ulnar or radial after access
41
Q

achieving “widest” or perpendicular flourscope view to the native vessel plane is critical to _____.

A

acurately aligning the devices

42
Q

if gap is larger than 1 mm around the immediate electrode region, then_____.

A

reposition catheters prior to activation

43
Q

indicators of false alignment:

A
  • electrode is not compressed
  • electrode appears behind the backstop
  • no tissue gap evident
44
Q

risks of false alignment:

A
  • failure to form fistula
  • extravasation/ psuedo
45
Q

if catheters fail to align properly on the first attempt:

A
  1. fully disengage all magents by retracting a catheter
  2. perform venogram or otherwise adjust flouroscope to more perpendicular view
  3. consider relocating catheters to better postion
46
Q

(true or false) catheters can still activate if greater than or equal to 50% of magnets are coapted

A

true

47
Q

(true or flase) the wavelength 4F device may be activated up to 3x in a single procedure

A

true

48
Q

why is it reccomended to embolize a bracial vein for patients with more than one bracial vein?

A

redirects flow superficially to help maturation

49
Q

perform final fistulagram to ensure:

A
  1. efficient flow is diverted superficially
  2. EndoAVF is patent
  3. stable embolization placement
50
Q

2 opportunities for cannulation:

A
  • split flow AVF
  • single vessel AVF
51
Q

what is a bruit?

A
  • vascular murmur, rumbling sound you can hear
  • often heard therough a stethoscope as consistent swoosh or whistle
52
Q

what casuses a bruit?

A

high pressure flow of blood through AVF

53
Q

what is a thrill?

A
  • rumbling sensation you can feel
  • felt on overlying skin as a vibration
54
Q

changes in bruit or thrill can indicate _____.

A

an issue (clot, narroing) of AVF

55
Q

first week cannulation suggested needles?

A

17 gauge needles

56
Q

second week cannulation suggested needles?

A

16 gauge needles

57
Q

thrid week cannulation suggested needles?

A

prgoress to larger needles

58
Q

overall how many petients were studied with either wavelinQ 6F or 4F EndoAVF system?

A

216 patients

59
Q

4F global analysis pooled data set:

A
  • 3 studies with combined 91 4F patients
  • same inclusion/ excusion criteria
  • same primary endpoints
60
Q

Device related SAE for wavelinQ:

A
  • 3.3% (3/91)
  • 1 thrombosis of endavf
  • 1 stenosis of endoavf
  • 1 access of false aneurysm
61
Q

procedure related SAE for wavelinQ:

A
  • 5.5% (5/91)
  • 2 endoAVF stenosis
  • 1 access circuit hemotoma
  • 1 access circuit false aneurysm
  • 1 endoAVF thrombosis
62
Q

what was the primary patency at 6 months:

A

72.4%

63
Q

what is secondary patency at 6 months:

A

77.3%

64
Q

What are Access options for Hemodialysis? (Select all that apply)

A

A) AV Fistula
B) AV Graft
C) Hemodialysis Catheter
D) EndoAVF

65
Q

How long does it take for an Arteriovenous or AV Fistula to mature?

A

2-6 months

66
Q

The most important aspect of WaveLinQ is:

A

Patient Selection

67
Q

What are possible WaveLinQ EndoAVF access sites (Select all that apply)

A

A) Ulnar Vein
B) Radial Vein
C) Brachial Artery and Brachial Vein

68
Q

Which vessel can be used for arterial access?

A

Brachial

69
Q

WaveLinq Uses RF (Radio Frequency) energy to create a WaveLinQ EndoAVF?

A

True

70
Q

Arterial closure devices are approved post procedure for brachial artery hemostasis

A

False

71
Q

Which of the following qualifies a patient for an EndoAVF candidate (Select all that apply)

A

A) Good Inflow (Artery over 2mm)
B) Good Outflow (Superficial vein greater than 2.5mm)
C) Presence of a perforator over 2 mm
D) Adequate creation site

Vascular (24 decks)

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